Repair Integrity and Functional Outcomes Between Knot-Tying and Knotless Suture-Bridge Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial

Abstract

Background: Knot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates. Purpose: To compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial). Results: Overall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03). Conclusion: Both techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique. Registration: NCT03982108 ( ClinicalTrials.gov identifier).

Types of Retears After Knot-tying and Knotless Suture Bridge Rotator Cuff Repair: A Systematic Review and Meta-analysis

“…The 12 articles included a total of 1411 shoulders, with tear sizes being medium in 4 studies, 12 , 13 , 16 , 22 medium to large in 3 studies, 9 , 28 , 29 small to massive in 2 studies, 10 , 23 and not reported in 3 studies. 3 , 11 , 19 One study 23 was categorized as having level 1 evidence, 3 studies 3 , 13 , 22 had level 2 evidence, and 8 studies 9 – 12 , 16 , 19 , 28 , 29 had level 3 evidence. The studies had a MINORS score ranging from 15 to 19, indicating that the methodology was fair to good.…”

“…Eleven studies 3 , 9 – 13 , 16 , 19 , 22 , 23 , 28 reported the overall retear rate of both knot-tying and knotless techniques. The overall retear rates of the knot-tying and knotless group were 20.1% and 20.4%, respectively.…”

“… 9 , 28 , 29 However, a recent prospective randomized controlled trial comparing clinical and radiological outcomes between knot-tying and knotless medial row techniques found type 2 failure rates to be significantly higher when using the knot-tying medial row technique. 23 …”

SpeedBridge Knotless Double-Pulley Rotator Cuff Repair

“…The associated lower risk of type 2 repair failures with using knotless techniques has been thought to be advantageous. 9 A recent meta-analysis similarly found no difference in clinical outcomes between knot-tying and knotless double-row arthroscopic RCR, as well as comparable retear rates between techniques. One study included in the analysis found a significantly lower retear rate in the knotless group.…”

“…In a prospective randomized controlled trial, Sahin et al. 9 found that the standard knot-tying and the knotless technique during suture-bridge rotator cuff repair both resulted in significant improvement of clinical outcomes at mid-term follow-up, including comparable postoperative range of motion, pain, and functional outcomes. Both techniques also had similar retear rates; however, retear pattern differed significantly, with the knot-tying technique resulting in significantly greater type 2 (medial) retears, while the knotless technique was associated with greater type 1 (lateral) retears.…”